Pain in the back of the heel is very common as the majority of the population has a tight heel cord.  This is due to various reasons such as high heel use, foot and ankle deformities and sports injuries.  Achilles tendon ruptures happen in the classically described “weekend warrior”, which is a middle-aged person who sporadically on some weekends tries to play a sport such as tennis or basketball at a higher than normal intensity.  They have played their sport in high school or college in the past and currently have not played on a regular basis.  Quite frankly they are “out of shape” and their bodies are not used to playing the sport at this high level. 

What Causes Pain in Back of the Heels:

However, the most common cause of Achilles tendon ruptures that I see lately is not a specific high-impact sport injury rather it is due to chronic longstanding Achilles tendon pains that has been years or even decades in the making.  It is the middle-aged, overweight man mostly but sometimes woman who has a history of chronic Achilles tendon pain.  They could be working in the garden, lifting a heavy package or even walking briskly across the street and all of a sudden they hear and feel a “pop” and have sudden, excruciating pain.  This is the most common type of rupture I see lately and as stated earlier the rupture is years in the making. 

In these situations, before the rupture happens there is something called tendinopathy or a noticeable thickening of the tendon and even small tears in the tendon occur.  This scarred or degenerated, thick tendon is weak and not as strong compared to a thinner, healthy tendon.  Achilles tendonitis or inflammation of the tendon occurs followed by Achilles tendinosis or scarring of the tendon and finally a rupture occurs. 

Treatment for Achilles Tendonitis:

Treatment for this inflammation and degeneration of the Achilles tendon involves stretch, stretch and more stretching at home and with a formal program of physical therapy.  There is no such thing as too much stretching.  Treatment also involves wearing a pair of functional, prescription, customized orthotics obtained from a podiatrist.  Functional orthotics are devices or inserts used to control excessive foot motion and tightness of the tendon.  They are not functional or useful if obtained from your local drugstore.  Also, temporary heel lifts are used to reduce the pull off the Achilles in order to allow the tendon to rest.  Anti-inflammatory medications and ice often help for acute tendonitis.  Most often, patients ignore these pains and seek treatment when it is too late and the rupture occurs. 

Achilles tendon ruptures can occur anytime when you have a weak or degenerated tendon, so prevention is the key.   If you notice any pains in the back of the heel, Achilles rupture prevention starts by first seeking treatment by your local podiatric foot and ankle specialist.  Once the pain resolves, prevention involves a proper, daily stretching regimen and functional foot and ankle control with the use of a pair of functional orthotics.

Peter Wishnie, D.P.M.
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Owner of Family Foot & Ankle Specialists in Piscataway and Hillsborough, NJ. Make an appointment today!